Laurie slipped the PA's report back into its folder. Her initial impression was that the emergency-room diagnosis was in error, and she had a reasonable idea of what she would find on the autopsy. Of particular note, she was reasonably certain she would not need any special equipment for the post.
Next, Laurie took out the PA's report on her third case. It was very short. It merely said that Ronald Carpentu had been on a semirecumbent stationary bike, which he used most every day, and had suddenly collapsed. Immediate CPR had been given by the health club's personnel but without success, 911 had been called, and the CPR was continued en route to the emergency room. On arrival, the patient was declared dead with the diagnosis of a severe heart attack.
Laurie replaced the PA's report. On this third case, she was quite certain the emergency-room diagnosis would prove to be correct, but there was still the question of why. Laurie guessed atheromatous heart disease. Again, she would not need any specialized equipment.
Picking up the phone, she called down to the autopsy room. It rang six times, causing Laurie to drum her fingers on her desk. While she waited, she thought about the weird coincidence of her giving Chet advice about dating Angela Dawson, of all people.
"Hello," a voice said, sounding more like "Yellow."
Laurie asked for Marvin, and after only a few seconds, he came on the line. "Are we ready?" Laurie asked.
"We've been ready for hours," Marvin joked.
Less than five minutes later, Laurie was suited up and staring down at Ramona's corpse. As with David Jeffries, an endotracheal tube and a number of intravenous lines were still in place. But the most striking thing was the extensive bruising over much of her body from the liposuction.
"You are motivated today," Marvin said, in a reference to how quickly Laurie had gotten down to the basement level, changed into her barrier protective gear, and come into the autopsy room. Besides her case, there was only one other under way, and that was the floater. Laurie hadn't even stopped to see how it was going.
"I want to be as efficient as I can," Laurie admitted. "I promise I won't leave you high and dry like I did yesterday. I apologize again. I got sidetracked and lost all idea of the time."
"No sweat," Marvin said, seemingly embarrassed that Laurie felt she needed to apologize.
Laurie palpated Ramona's skin and looked at it closely. It had a spongy feel, and there were multiple tiny abscesses such that Laurie felt that had she lived, she would probably have sloughed off a large part of her epidermis.
After taking a number of photographs, Laurie began the case. She worked quickly and silently. When Marvin asked questions, she answered as if preoccupied, and he soon stopped. Since they worked together so often, there was little need to talk.
As with David Jeffries, the most notable pathological finding, besides the extensive cellulitis, was in the lungs. Both were fluid-filled and contained innumerable small abscesses that would have coalesced into larger and larger ones had the patient lived. As with Jeffries, the necrosis was substantial.
When the final suture had been placed, closing the autopsy incision, Laurie stepped back from the table. She glanced around the room. Now, all eight tables were being utilized. Looking over near the door, she could see that Jack, Lou, and Vinnie were still involved with the floater.
"That was one of the fastest autopsies I've seen," Marvin commented, as he began to clean up.
"How soon can you have the next case?" Laurie asked.
"Fifteen minutes or so," Marvin said. "Do you have a preference as to which one of the two should be next?"
"It doesn't matter," Laurie said. "I wouldn't fault you if you don't believe me, but I'm going upstairs to make one phone call, and then I'll be back."
Marvin smiled.
Laurie stopped briefly at Jack's table and jokingly asked why he was taking so long. Jack was known to be one of the fastest prosectors.
"Because these two windbags talk like a couple of old ladies," Vinnie said disgustingly.
"We're being thorough," Jack said. "Even before the micro and the lab contribute, we know this young woman was raped rather brutally."
"Which raises the question," Lou said, "was it a rape followed by a homicide, or was it a homicide and an incidental rape?"
"Unfortunately, the autopsy is not going to provide us with an answer to that question," Jack said.
Laurie excused herself and exited via the washroom to ditch her gloves and Tyvek disposable suit. Her face mask she wiped clean with alcohol and left it in her locker. Intent on not keeping Marvin waiting, she dashed upstairs.
Back in her office, Laurie dialed Dr. Silvia Salerno at the CDC. As the call went through, she wedged the phone between her head and shoulder to free her hands. Shuffling through the case files on her desk, she located Chet's case, Julia Francova. She opened it up with the hopes of being able to add the subtyping of the patient's MRSA.
When the phone wasn't answered immediately, Laurie looked at the time. It was now going on nine, and she was certain the CDC had to be open for business. "Come on, come on!" Laurie urged. "Answer the damn phone."
Just when she thought about checking to see if the CDC had a paging system, the line was picked up. It was Silvia, and she was mildly out of breath. She immediately apologized, saying she had been in a neighboring office.
"I hope I'm not bothering you," Laurie said. "I know you said you'd be calling me, but the sooner I have some information, the better."
"Don't be silly," Silvia said. "You certainly aren't bothering me, and I was planning on calling this morning. I did check on those two MRSA cases of Dr. Mehta's. They are the same organism, and I can say that with definite certainty. Because we are adding these strains to the national library of MRSA, we go out of our way to characterize them, and we do this with multiple genetic methods, such as high-throughput amplified fragment-length polymorphism analysis. I could send you a list of the other methods we use."
"Thank you, but I don't believe that will be necessary," Laurie said. She had no idea what Silvia was talking about. "But I do have another case, which had been sent to you people a number of weeks ago for typing. Specifically, it was sent to a Dr. Percy."
"Dr. Percy is a colleague. What was the referring doctor's name?"
"Dr. Chet McGovern. He's a colleague of mine here at the OCME."
"What was the patient's name?"
Laurie spelled out the name to avoid any confusion.
"Hang on for a minute."
Laurie could hear the familiar sound of Silvia's keyboard, making her wonder how anything got done before digital computers.
"Yes, here it is," Silvia said. "Interesting! It's also CA-MRSA, USA four hundred, MWtwo, SCCmecIV, PVL, exactly like the two previous cases. Is it from the same institution?"
"It's from one of the same institutions," Laurie said. "Remember, the first two were from two separate hospitals."
"Yes, I remember. Concerning the two cases at the same institution, are they close to each other in time, maybe even the same date?"
Laurie turned to her unfinished matrix, but she did have the data from Mehta's case from the Angels Cosmetic Surgery and Eye Hospital. The patient's name was Diane Lucente, and like Ramona, she'd had liposuction. Laurie checked the date of Diane's death and Chet's case. "No," Laurie said. "They occurred almost three weeks apart."
"How odd," Silvia said. "I guess you know how genetically versatile staphylococcus is."
"I'm on a rather steep learning curve," Laurie admitted. "But I was informed of that yesterday."